© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Collecting, Processing, Collecting, Processing, and Testing Blood Specimensand Testing Blood Specimens

PowerPoint® presentation to accompany:

Medical AssistingThird Edition

Booth, Whicker, Wyman, Pugh, Thompson

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© 2009 The McGraw-Hill Companies, Inc. All rights reserved

Learning Outcomes

48.1 Discuss the composition and function of blood.

48.2 Describe the process for collecting a blood specimen.

48.3 Explain the importance of confirming patients’ identities and correctly identifying blood samples.

48.4 Describe how to perform venipuncture and capillary puncture procedures.

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Learning Outcomes (cont.)

48.5 Identify the equipment and supplies required for blood-drawing procedures.

48.6 Discuss the correct procedures for disposing of waste generated during blood-drawing procedures.

48.7 Discuss common fears and concerns of patients and how to ease these fears.

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Learning Outcomes (cont.)

48.8 Develop techniques for helping patients with special needs, including children, the elderly, patients at risk for uncontrolled bleeding, and difficult patients.

48.9 Identify common blood tests and explain their purposes.

48.10 Perform certain blood tests.

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Introduction

Medical assistant Collects blood specimens

Performs waived testing

Knowledge needed Understand circulatory system and function of blood Appropriate supplies and equipment How to perform and screen common blood tests

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Role of the Medical Assistant Phlebotomy – insertion of a

needle or cannula into a vein to withdraw blood

Put the patient at ease during procedure

Process specimens and conduct testing

Complete necessary paperwork and make sure specimens are handled properly

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Circulatory system transports blood Heart pumps 8–12 pints of

blood through 70,000 miles of vessels / day

Hematology – the study of blood

Functions and Composition of Blood

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Functions of blood Distributes oxygen, nutrients,

and hormones Eliminates waste products Attacks infecting pathogens Maintains acid-base balance Regulates body temperature

Functions and Composition of Blood (cont.)

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Red blood cells – erythrocytes Internal respiration

Transport oxygen to cells Hemoglobin – 98% Dissolved in plasma – 2 to 3 %

Hemoglobin Main component of RBCs Protein containing iron

Functions and Composition of Blood (cont.)

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White blood cells – leukocytes Protect against infection Granular

Basophils Eosinophils Neutrophils

Agranular T and B lymphocytes monocytes

Functions and Composition of Blood (cont.)

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Platelets – thrombocytes Fragments of

cytoplasm Essential for clot

formation

Plasma Clear, yellow liquid Contains formed

elements of blood 90% water

Serum Clear, yellow liquid

remaining after clot formation

Functions and Composition of Blood (cont.)

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Blood types or groups Presence of antigens A and B

determines type Blood also carries antibodies

Transfusions require careful matching to prevent hemolysis

Functions and Composition of Blood (cont.)

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Apply Your Knowledge

1. What is the role of the medical assistant related to collecting blood samples?

ANSWER: The medical assistant will put the patient at ease during the procedure, process specimens, conduct testing, complete necessary paperwork, and make sure specimens are handled properly.

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Apply Your Knowledge

ANSWER: Functions of the blood are: (list any 3)

1. Distributes oxygen, nutrients, and hormones

2. Eliminates waste products3. Attacks infecting pathogens4. Maintains acid-base balance5. Regulates body temperature

2. What are three functions of blood?

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Collecting Blood Specimens Reading and

interpreting the test order Review order

Assemble equipment and supplies

Preparing the patient Greet and identify the

patient

Confirm pretest preparation

Explain the procedure and safety precautions

Establish chain of custody

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Collecting Blood Specimens (cont.)

Use Standard Precautions and PPE as needed

Handling exposure incident Needlestick or other exposure to blood / blood

products Report to appropriate person immediately Wash area and apply bandage Document date, time, people involved, type of

exposure

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Collecting Blood Specimens: Drawing Blood

Not all states permit medical assistants to draw blood

Venipuncture Puncture of a vein Most common sites are

in the anticubital fossa and forearm Common Sites for

Venipuncture

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Collecting Blood Specimens (cont.)

Venipuncture complications Hematoma

Hold needle still Hold pressure on site

after removal of needle

Latex allergy Ask patient Use non-latex gloves,

tourniquet, and bandages

Nerve injury Know anatomy

Infections Rare Clean site prior to

venipuncture May not be evident

for several days

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Collecting Blood Specimens (cont.)

Equipment Evacuation systems – use special double-pointed

needle, needle holder Needle and syringe systems Butterfly system – winged infusion set and

syringe Collection tubes

Sealed to create a vacuum Color-coded to identify appropriate additive

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Collecting Blood Specimens (cont.)

Engineered safety devices Reduce the possibility of needlestick

injuries Types

Retracting needles Hinged or sliding shields Self-blunting needles Retractable lancets

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Collecting Blood Specimens (cont.)

Capillary puncture Superficial puncture of

skin with sharp point

Lancets / automatic puncturing devices

Micropipettes – small calibrated glass tubes that hold a small, precise volume of fluid

Reagent products Chemically treated

paper or dipstick Smear slides

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Apply Your Knowledge

What precautions should you take when collecting a blood specimen?

ANSWER: You should use Standard Precautions and appropriate personal protective equipment.

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Responding to Patient Needs

Respond with sensitivity and competence

Fears and concerns Pain

Bruises or scars

Serious diagnosis

Contracting a disease from the procedure

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Responding to Patient Needs: Special Considerations Children

Talk with parent or caregiver first Address child directly Speak in a calm, soothing voice Explain the procedure briefly in

terms they can understand Keep child informed of status

during the procedure

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Elderly Prone to bruising Difficult to obtain an adequate

sample Speak clearly in a low-pitched

voice Allow adequate time for patient to

respond to questions

Responding to Patient Needs: Special Considerations (cont.)

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Risk of bleeding Hemophilia or taking

blood-thinning medication

Hold site for at least 5 minutes

Contact physician if bleeding does not stop

Responding to Patient Needs: Special Considerations (cont.)

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Difficult patients Difficult

venipuncture – do not stick more than twice

Fainting patients – Reaction to blood

draw Position to avoid

injury

Angry or violent patients Explain need for

testing Avoid arguing Do not force patient Document behavior

and if patient refuses

Responding to Patient Needs: Special Considerations (cont.)

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Apply Your Knowledge

ANSWER: After drawing blood on a patient taking anticoagulants, you should hold a cotton ball over the puncture site for at least 5 minutes, monitor the site carefully, and notify the physician if bleeding does not stop.

What is one precaution you can take when drawing blood from a patient who is taking anticoagulants?

Correct!

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Performing Common Blood Tests Results aid in diagnosis

POLs often only perform waived tests

Know office policy

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Performing Common Blood Tests (cont.)

Chemicals in lab Anticoagulants – keep blood in uncoagulated

state

Serum separators – form a gel-like barrier between serum and clot in coagulated sample

Stains – color particular cells

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Performing Common Blood Tests: Hematologic Tests

Blood counts RBC count White blood cells Differential white blood cell Platelet Hematocrit Hemoglobin

Centrifuged Capillary Sample

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Morphologic studies Morphology – study of shape and form of objects Requires special training

Coagulation tests Identification of potential bleeding problems Monitor therapeutic drug levels for anticoagulants PT and PTT

Performing Common Blood Tests: Hematologic Tests (cont.)

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Erythrocyte sedimentation rate Measures rate of RBCs falling to the bottom of

the blood sample

Must be performed on a fresh sample

Tube must contain an anticoagulant

Read after one hour

Recorded as mm/hr

Performing Common Blood Tests: Hematologic Tests (cont.)

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Performing Common Blood Tests: Chemical Tests

Rarely performed in

the POL

Waived tests Blood glucose

monitoring

Hemaglobin A1c

Cholesterol tests

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Performing Common Blood Tests: Serologic Tests Introduction of an antigen or antibody into a

specimen and detection of a reaction to it

Immunoassays Western blot Radioimmunoassay

(RIA) Enzyme-linked

immunosorbent assay (ELISA)

Immunofloruescent antibody (IFA) test

Rapid screening tests Infectious

mononucleosis HIV Helicobactor pylori

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Apply Your Knowledge

Matching:

___ Hemoglobin A1c A. ESR

___ Lysing RBCs / evaluating the color B. Serology test

___ Shape or form of objects C. Coagulation tests

___ Identify bleeding problems D. Chemical test

___ Rate at which RBCs fall E. Differential

___ Percentage of each type of WBC F. Morphology

___ ELISA G. Hemoglobin

ANSWER:

G

F

E

D

C

B

A

Super!

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In Summary

Phlebotomy procedures require Technical skills Interpersonal communication skills

Medical assistant Patient instructions Completion of testing procedures

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End of Chapter

Blood will tell, but

often it tells too much.

~ Don Marquis